House Call

Telemedicine connects patients and doctors with new technology—just like in the old days.

Doctors don't make house calls anymore—or do they?

Telemedicine uses communication technology to allow patients "to feel the presence of the doctor" in their own homes.

They do if they're Dartmouth-Hitchcock Norris Cotton Cancer Center doctors. No, they don't ride up to a house in a carriage, carrying a black bag. But, thanks to technology, they do talk to patients where the patients live, in their kitchens and bedrooms, in their living rooms, out in their yards.

The new Office of Telehealth at Dartmouth-Hitchcock is developing networks to bring doctors to far-flung rural and city-dwelling patients. Working with the Northeast Telehealth Resource Center, Sarah Pletcher, MD, is finding ways, she says, "to connect patients and doctors through technology." Sometimes that means using a high-definition video-conferencing tool such as Skype, but it can also mean something as simple as a "tweet" to a cell phone via Twitter. There are also "a bazillion" smart-phone apps available for telehealth communication, she says, "though some are better than others."

Feeling the presence of the doctor

For a patient, what telehealth means is having a direct link, via computer, i-notebook or pad, cell phone or smart phone, to their health provider. This is particularly valuable to cancer patients, who often find travel to a medical center to be difficult and uncomfortable. But a telehealth network allows patient and doctor to keep in touch with each other about daily issues, including prescription drug use, food intake, sleep or lack of sleep, exercise, general well-being, and so forth. Patients still go to clinics and hospitals for procedures and treatments such as chemotherapy infusions.

"Telemedicine is a way for patients to feel the presence of their doctor," comments Dr. Pletcher. Cancer patients, especially, "are in an acutely vulnerable phase. When they leave the medical center or Cancer Center, they're usually feeling overwhelmed with information and what they have to do. With Skype or text-messaging or email, the doctor can check in on them frequently and help alleviate some of that stress." Patients have an opportunity to ask questions and receive responses quickly, usually within hours and sometimes within minutes.

"Telemedicine is not something different," points out Kim Mehan, director of the Northeast Telehealth Resource Center. "It's the same care with a new tool."

Don't leave home without it

Interestingly, access to technology and the Internet isn't as big an issue as one might think, even for people who live far out in the country. Dr. Pletcher notes that studies show smart-phone use is surprisingly high among rural families. Why? A smart phone is cheaper than a computer, yet it provides just as much Internet access – access that's often free at wi-fi hotspots such as coffee shops and libraries.

"Smart phones are almost part of our bodies now," she adds. "If you have one and it's your only tool for accessing the Internet, you won't leave home without it. That means that a doctor has access to you." She notes that several smart phone apps are available that keep track of things like steps taken during the day, levels of physical activity hour by hour, foods bought and consumed, hours of deep sleep, etc. Such apps can provide a database of information to give both doctor and patient a picture of how the patient is doing on an hourly, daily, and weekly basis. As Dr. Pletcher says, "it gives the patient a way to quantify for the doctor what it is like to be the patient – what it is to be me."

Another advantage is the access telemedicine gives to cloud-based translation services. In a city such as Manchester, NH, where more than 100 different languages are spoken, real-time translation is invaluable.

Doctor-to-doctor

Telemedicine tools are also increasingly being used for provider-to-provider communication. "A primary care provider can communicate with a specialist such as an oncologist, and a specialist can communicate with a sub-specialist, all very quickly," says Dr. Pletcher. "Telemedicine is most valuable, I think, as a tool to access specialty resources, which otherwise might be remote or difficult to reach. With teleconferencing, for example, it's easy to bring in the expertise of a specialist from another city or state to a local patient. It's a great way to enrich that vital communication for the benefit of the patient."

She's careful to emphasize that important problems still need to be fully addressed. Privacy, for one thing: not all information transmitted over the Internet is necessarily secure. The old equation is still in effect: the easier a technology is to use, the easier it is for others to abuse. And Dr. Pletcher emphasizes that telemedicine will never replace face-to-face meetings between doctor and patient. "Often the most important thing I do is simply show up in a white coat," she says. "Many patients take comfort just from that. But telemedicine does give us a tool to enhance and enrich the patient-doctor relationship."

The new way for patients to communicate

She adds: "We all shop for healthcare online now. Patients come to their doctor armed with information they've found on the Internet. They compare this or that. Telemedicine is a way to complement that reality. It's not a replacement for anything, it's a new way to communicate."

Dartmouth-Hitchcock's Office of Telehealth is now developing its first pilot programs, and will have full contact information available soon. The Northeast Telehealth Resource Center can be reached at (207) 622-7566 ext. 283 or 1(800) 379-2021. Website: www.netrc.org